The boy had fallen of his bike and had sustained a blunt abdominal trauma by the handle bar of his bike 10 hours prior to the ultrasound examination. He was hemodynamically stable, but had pain in his left upper abdomen.
Acute pancreatic ruptures are difficult to diagnose with ultrasound. When there is no blood in the defect, they can easily be overlooked. Ultrasound is very sensitive in detecting fluid, but parenchymal lesions can sometimes be missed. CT is more sensitive than ultrasound in detecting parenchymal lesions. The patient was discussed with a larger pediatric trauma centre, but because he remained hemodynamically stable the treatment of choice remained conservative treatment. The fluid collections that developed were percutaneously drained under ultrasound guidance.
References
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Am J Emerg Med. 2010 Jul;28(6):745.e3-4
Percutaneous drainage treatment of traumatic pancreatic rupture with pancreatic transection.Martinez-Ramos D, Cifrián-Pérez M, García-Vila JH, Salvador-Sanchís JL, Hoashi JS.
Gastroenterol Hepatol. 2010 Feb;33(2):102-5.